GP Locums: Vectors of Innovation

Imagine that this care was provided based on clinical need, not your ability to pay.

Imagine if we arranged it so that it was provided free at the point of delivery as well.

If we didn’t have this already, you’d laugh me out of the room

The National Health Service is the very definition of a disruptive innovation.

The NHS was born into a country emerging from the rubble of a World War, where food and basic amenities were rationed. The concept behind it was so radical that many doctors fought to prevent it coming into existence. Yet, created it was, and nearly 70 years later it continues to make good on those three founding principles.

You’d think that a health service so radically innovative would be receptive to innovation, but in the twenty years I’ve been working in the NHS I’ve come to see that it is anything but. The pressure not to mess with the formula is high.

No-one wants to be the person that broke the NHS.

Bureaucracy and the conservatism of the medical profession preserve the status quo. Any innovation has to be controlled and managed: only proven innovations are to be permitted.

That’s not really how innovation works though.

I’m a ‘lifer’ – the NHS has been caring for me since before I was born, and I’ve been raised, trained, work, and (with any luck) I’ll retire, be cared for, and eventually die in a world where the NHS continues.

I want to play my part to ensure that this be the case, but I’ve never felt that there was a recognized career path for me as a technologically minded doctor. I’ve been forced therefore, to try and bring tech in to my work “on the side”, often on my own, in my own time, and experiencing considerable resistance.

I affectionately refer to some of my attempts as: “The Good, the Bad, and the Ugly”.

The “Good” are innovations that work well within the boundaries of the NHS. I collaborated on an ingenious project called ‘MyLittleOne’ recently which, using a specially developed camera and iPad system, allows mothers to see their babies when they’re receiving care in the Neonatal ICU.

The “Bad” are those that don’t work, or don’t scale. They also tend to be the ones that are solution led, rather than problem driven. In my case, it was Google Glass that seduced me. I may have looked foolish as an early adopter, but I learned valuable lessons that have led to my CCG being on the brink of using this technology to provide remote care in local nursing homes.

The “Ugly”? Those innovations are the ones which, although born outside healthcare seem to work perfectly within. Often harvested from personal interests, my experience of one such innovation has been with the early successes I’ve had in using Virtual Reality to reduce pain in patients having wound dressings.

The common thread in the success or failure of all three types was the fact that problems need to come before solutions. This is surprisingly difficult to achieve, given the lure of new gadgets and technology.

Much like every NHS employee, locums and sessional doctors are expected to know their job, and get on with it: turning up, seeing the patients, and not upsetting the apple cart.

Yet locums probably have the most to offer when it comes to innovation. Who else sees the breadth of the NHS, working in practices large and small, in- and out-of-hours, and in some of the most challenging circumstances?

They have a unique perspective of not only the problems of their particular clinical existence, but also the issues that those working in one place might overlook. They see solutions in one place that might work somewhere else. Locums are vectors of innovative practice. They may have already developed solutions, innovations, and wanted to share them, but not know how.

The NHS needs to recognise the fantastic resource it has in the sessional workforce and provide help and opportunity for them develop their ideas further. I’ve seen evidence of change in the mindset of the leadership of the NHS, especially in the work of our National Clinical Lead for Innovation, Professor Tony Young, who heads the Clinical Entrepreneur Programme. You can also look to groups such as Doctorpreneurs.

Aren’t we also masters of self-organisation? Why don’t we upgrade our own networks to be more supportive of innovation and entrepreneurship? Perhaps that idea you have, that innovation you’re working on, could be turned into something larger with a little help or guidance?